Endoscopic ultrasound elastography for differential diagnosis of pancreatic masses: a meta-analysis

BACKGROUND

Distinguishing malignant from benign pancreatic tumors is challenging with current imaging techniques. Endoscopic ultrasound (EUS) elastography has further improved the efficacy of EUS for characterizing pancreatic lesions.

AIMS

To assess, by combining data from existing trials, the accuracy of EUS elastography in diagnosing malignant tumors for patients with pancreatic masses.

METHODS

All relevant studies published were identified by systematic searching of databases. A meta-analysis was performed using a random-effects model to combine study results.

RESULTS

Seven studies involving 752 patients were included. The sensitivity of EUS elastography for differential diagnosis of solid pancreatic masses was 97 % (95 % CI, 0.95-0.98), and the specificity was 76 % (95 % CI, 0.69-0.82). The area under the curve under summary receiver operating characteristic (SROC) was 0.9529. The combined positive likelihood ratio was 3.71 (95 % CI, 2.72-5.07), and the negative likelihood ratio was 0.05 (95 % CI, 0.02-0.13).

CONCLUSION

Our meta-analysis shows that EUS elastography is a useful tool for differential diagnosis of solid pancreatic neoplasms with very high sensitivity and relatively low specificity. The results indicate that EUS elastography not only provides information complementary to that from EUS but also potentially increases the yield of fine needle aspiration and reduces the number of unnecessary biopsies.

Contrast-enhanced EUS for differential diagnosis of pancreatic mass lesions: a meta-analysis

BACKGROUND

Distinguishing pancreatic adenocarcinomas from other pancreatic masses remains challenging with current imaging techniques. Contrast-enhanced EUS further improved the efficacy of EUS to characterize pancreatic lesions.

OBJECTIVE

To assess the accuracy of contrast-enhanced EUS for diagnosing adenocarcinoma in patients with pancreatic masses by pooling data of existing trials.

DESIGN

We systematically searched the Medline, PubMed, Web of Science, Embase, and Cochrane Central Trials databases for relevant studies published. Meta-analysis was performed. Pooling was conducted in a fixed-effect model or a random-effects model.

PATIENTS

Twelve studies involving 1139 patients were included.

INTERVENTION

Contrast-enhanced EUS.

MAIN OUTCOME MEASUREMENTS

Meta-analysis and meta-regression analysis.

RESULTS

The pooled sensitivity of contrast-enhanced EUS for the differential diagnosis of pancreatic adenocarcinomas was 94% (95% CI, 0.91-0.95), and the specificity was 89% (95% CI, 0.85-0.92). The area under the curve under summary receiver operating characteristic was 0.9732. The pooled positive likelihood ratio was 8.09 (95% CI, 4.47-14.64), and the negative likelihood ratio was 0.08 (95% CI, 0.06-0.10). The subgroup analysis by exclusion of the outliers provided a sensitivity of 93% (95% CI, 0.91-0.95) and a specificity of 93% (95% CI, 0.89-0.95) for the differential diagnosis of pancreatic adenocarcinomas. The area under the curve under summary receiver operating characteristic was 0.9745.

LIMITATIONS

A small number of studies met the inclusion criteria.

CONCLUSION

Contrast-enhanced EUS is a promising, reliable modality for the differential diagnosis of pancreatic adenocarcinoma in patients with pancreatic mass lesions. The finding of a hypoenhanced lesion was a sensitive and accurate predictor of pancreatic adenocarcinomas. It seems to be a useful tool in clinical practice.

Natural Orifice Translumenal Endoscopic Surgery (NOTES): patients' perceptions and attitudes

BACKGROUND

Natural orifice translumenal endoscopic surgery (NOTES) has generated a surge of enthusiasm among researchers by virtue of its challenge to the dogma and potential benefits. However, no data is available in the medical literature about NOTES' acceptance by patients in Asia. The aim of the study is to survey patients' perceptions and attitudes towards NOTES.

METHODS

It is a questionnaire-based multi-center study on inpatient subjects with various gastrointestinal disorders from 14 hospitals in 12 cities of China. Procedural details with the benefits and risks of NOTES, laparoscopic surgery, and conventional surgery were explained to all registered candidates. They were required to choose and cite reasons for adopting one of the above three surgical techniques as the preferred mode of treatment. The reasons for selection of the surgical treatment were: safety, efficacy, cost, postoperative pain, abdominal wounds, and scarring.

RESULTS

There were 1,797 cases, including 976 (54.3%) males and 821 females (45.7%). Based on their comprehension of the procedure, 802 (44.6%) patients opted for NOTES, 757 (42.1%) for laparoscopic surgery, and 238 (13.2%) for conventional surgery. NOTES was mainly selected by the young and educated persons, especially females and by those with past exposure to laparoscopy or conventional surgery. The choice of treatment was significantly correlated with age (P=0.0021), education (P=0.0209), past medical history (laparoscopy, P=0.0134; open surgery, P<0.0001), and department of admission (P=0.0173). The preference for NOTES was based on safety (37.3%), cost (17.6%), elimination of postoperative scars (16.1%), abdominal wounds (16.0%), and efficacy (13.1%).

CONCLUSIONS

The vast majority of patients prefer mini-invasive surgery to conventional surgery. The potential recipients of NOTES are educated and younger age groups. However, a few consider NOTES as a safe and effective intervention at present.

Effect of rebamipide on quality of peptic ulcer healing in rat

The aim of this study is to elucidate the effects and the mechanism of rebamipide, omeprazole, and their combination treatment on quality of peptic ulcer healing (QOUH). Peptic ulcer models were induced by acetic acid exposure of the serosa of rat stomach. Forty Sprague-Dawley (SD) rats were divided randomly into four groups of ten rats each. Saline 2 ml/d (group 1), rebamipide 60 mg/kg/d (group 2), omeprazole 10 mg/kg/d (group 3) as well as its combination regimen (group 4) were administrated for 7 days. After sacrifice, size of the ulcer and focal layer structures were measured in vitro by miniature ultrasonic probe, and the mucosal sections were stained with hematoxylin and eosin (HE) for histological examination; the levels of interleukin (IL)-8/prostaglandin E(2) (PGE(2)) were evaluated by enzyme-linked immunosorbent assay (ELISA) and malondialdehyde (MDA) level was evaluated by thiobarbituric acid (TBA) method. Macroscopically, compared with the control group, the maximal diameters of the ulcers in the medication groups were significantly reduced (P < 0.05), and the layer echo structures of gastric wall were partially rebuilt. Histologically, ulcer range and inflammatory infiltration were less severe compared with the control group. In addition, mucosal MDA and IL-8 levels were significantly decreased, while PGE(2) level was significantly increased in the medication groups. Between the two monotherapy groups, there was no statistical difference in terms of PGE(2) and MDA levels. However, PGE(2) level was significantly increased, while MDA and IL-8 levels were significantly decreased in the combination group. Rebamipide as well as omeprazole and the combination regimen may improve QOUH through increasing the level of PGE(2), decreasing the levels of IL-8 and MDA in gastric mucosa, and this may potentially result in reduced recurrence of ulcer; moreover, the combination regimen was identified as having more antiulcer effects than monotherapy.

Primary non-Hodgkin's lymphoma in the esophagus

Lymphoma is a malignant neoplasm classically involving the lymph and reticuloendothelial tissues. According to the World Health Organization classification (2000) for non-Hodgkin's lymphoma (NHL), there are over 20 different subtypes, each with its own characteristics and behavior. Gastrointestinal lymphoma is a less common type of NHL, usually affecting the stomach, colon and small intestines. The esophagus, however, is rarely involved. Here the investigators report a case of primary NHL of the esophagus so that this may be of help to physicians in future encounters.

[Effect of changji'an on visceral hypersensitivity in rats with irritable bowel syndrome and its mechanism]

OBJECTIVE

To explore the mechanism and efficiency of Changji'an (CJA) in treating irritable bowel syndrome through studying the relationship between serotonin transporter (SERT) and visceral hypersensitivity in rats.

METHODS

Male SD rats were randomly divided into 4 groups: the normal control group, the model group, the high-dosage and low-dosage CJA (CJAH and CJAL) groups. Visceral hypersensitivity model was established by colorectal distension. Normal saline and different doses of CJA were administrated to rats respectively, starting from the 10th day of modeling for 10 days. After then, the abdominal withdrawal reflex (AWR) was scored for semi-quantitative estimation of visceral sensitivity, and tissues of brain and colon were harvested for detecting expressions of SERT and serotonin (5-HT) with Western blot, real-time PCR and immunohistochemistry.

RESULTS

As compared with the normal controls, in model rats, the AWR score and content of 5-HT in intestinal mucosa were higher (P < 0.05), protein and mRNA expressions of SERT in colon and nucleus raphes dorsalis (NRD) were lower (P < 0.05), but all these indexes were improved significantly after CJA treatment, either in the CJAH or CJAL group (all P < 0.05). Besides, the number of 5-HT energic neuron in the model group and CJA groups was lower than that in the normal control group (P < 0.05).

CONCLUSION

CJA has therapeutic effect for improving visceral hypersensitivity in irritable bowel syndrome by way of regulating colonic expression of SERT and content of 5-HT.

[The effects of octreotide on portal hemodynamics in patients with liver cirrhosis]

OBJECTIVE

To compare the portal hemodynamic effects of different doses of somatostatin analogue octreotide (sandostatin) with beta-blocker (propranolol) on prevention of early variceal re-bleeding in patients with cirrhotic portal hypertension.

METHODS

Thirty patients of cirrhosis with moderate to severe esophageal varices were randomly allocated into three groups. 10 patients in group A were given propranolol 10-20 mg orally three times a day for 7 days; 10 patients in group B were administrated octreotide 0.05 mg subcutaneously two times a day for 3 days, while 10 patients in group C received octreotide 0.1 mg subcutaneously two times a day for 3 days. The postprandial vessel diameter, maximal and average flow velocity (Vmax/V) and flow volume of portal vein (PV), splenic vein (SV) and superior mesenteric vein (SMV) were measured before and after therapy by using Echo-Doppler technology.

RESULTS

There was a trend of decrease of the vessel diameter in all the three groups, but with no significant difference. However, the average velocity and flow volume of PV were significantly diminished in the propranolol group (P < 0.05), while there was no statistical change of them in SV and SMV groups. In octreotide 0.05 mg and 0.1 mg group, the average velocity and flow volume of PV, SV and SMV were significantly decreased (P > 0.05). Besides, octreotide 0.1 mg group but not 0.05 mg group was more active in decreasing flow volume of PV as compared with the propranolol group, while both octreotide groups were superior to the propranolol group in decreasing flow volume of SV and SMV.

CONCLUSIONS

Octreotide may have potential prophylactic effect in prevention of early variceal re-bleeding in cirrhotic patients with portal hypertension.